Dateandtime Event/CEtopic LocationandRSVP

June Men’sHealthMonth Beaware!

Monday19thofJune6.30-8pm

AlliedHealthEducationEvening

TheAtrium,HagleyNetballcourts,HagleyAve.Seeattached.

Thursday22ndofJune PacificNutritionStudyDay

RSVPsclosed.Remindertothoseattending.

Tuesday18thofJuly StudentWelcome DuoCafé/bar,RollestonAve,fliertocome.

Canterbury Branch Newsletter June 2017

In this month’s issue

DatesfortheDiaryPresidentsreportLocalNews

- PureFoodCo- JuliaBryson’sConferencePoster

NewsfromDNZNewsandViewsHealthInfoUpdateConferenceReportAttached:

- AlliedHealthEducationSession

Dates for the Diary

WellIthoughtIwouldstartofmyfirstpresident’sblurbbybrieflyintroducingmyselfforthoseofyouwhodon’tknowme.AlthoughIfeellikeIdoknowalotofourlocaldietitians,sohopefullyalotofyouknowmeaswell!ThelastsevenyearsofmycareerhaveledmetoTimaru,Nelson,WellingtonandChristchurch,sooverthistime,Ihavehadthepleasureofmeetingalotofdietitians.IhaveworkedasaclinicaldietitianatTimaruHospital,NelsonHospital,completedashortstintinprivatepracticeinWellingtonandhavespentthelastthreeandhalfyearsbackatChristchurchHospital.MycurrentroleisworkinginENT,RadiationOncologyandorthopedics.WeheldthebranchAGMinMayandheardfromMichaelMayell,founderofCookieTime,abouthisnewproductNutrientRescue.Ihopeyouallfoundthisreallyinteresting!Ithoughtitwasgreattohearfromsomeonesosuccessful

andpassionateaboutsomethingandjustshowsthatintoday’snutritionworldbeingopenmindedandthinkingoutsidetheboxisreallyimportant.IfweallhadasmallamountoftheenthusiasmMichaelhasthendieteticswouldbeheadedinagreatdirection.Ournewbranchcommitteeisfilledwithyouthandexperiencesohopefullywewillbeabletokeepthebranchheadedinagreatdirectionoverthenextyear,pleasedropusalineifyoueverhaveanythingtosharewithus.That’senoughofmefornow.I’mmuchmoreofatalkerthanawritersoI’mgoingtokeepitshortandsweetandletyouknowtogetintouchwithmeifyouwanttohaveachatovercoffeeorwine.

Presidents Report

Recently,theDietitansatChristchurchHospitalwereluckyenoughtobevisitedbythefoundersofPureFoodCo.Theyhavewrittenaweeblurbtoletusknowalittleaboutthem.

Pure Food Co

ThePureFoodCowas establishedbySamBridgewaterandMaiaRoyalafterwitnessinga familymember’s illnessmakeitimpossibleforhimtogetthenutritionheneededthroughregularfood.Theyprovidedelicious, fortified foods to people in their own homes, aswell as hospitals and aged care facilities.Following a Food First approach, recent audits overseen by Kaye Dennison (NZRD) have shown some impressiveresults,asseenbelow:FullFacility(n=14)Chartshowingweightgain/lossintheperiodbeforetheprogrammewhichincludedintroducingPureFoods(June15-June16)andfollowingintroduction.

Theheatand eatmeals,designed to ensure everyonehas theopportunity to eatwell,arenowavailable throughNurseMaude’sHealth&MobilityShop,285WairakeiRoad,Bryndwr,inboxesof100gportions.Customersaremorethanwelcometostopbyforasample.

Care facilities interested in providing foods to enhance the meal experience, and nutritional uptake, can emaildirectlytogetasolutiontailoredtotheirneeds:info@thepurefoodco.co.nz.Ifanyonewouldlikeinformationorsamples,ThePureFoodCoarehappytoprovidetodietitians.

JuliaGardehasrecentlyconductedanauditoftheOncologyDietitianReferralsreceivedatChristchurchPublicHospital.Thefollowingposterprovidesanoverviewofresults,andwaspresentedatarecentconference.

Oncology Dietitian Referrals An audit of the quality and quantity at Christchurch Hospital

Julia Bryson Nutrition and Dietetics Department Christchurch Hospital,

Canterbury District Health Board, Christchurch, New Zealand

BackgroundThe quality of oncology dietitian referrals received and accuracy of nutrition screening on referrals varies. Our department also has no information on the number of patients that are seen by oncology dietitians, what some patients are referred for, who the main referrers to dietitians are; nor is there any specific dietitian referral criteria for medical oncology patients.

ObjectiveThe audit objective was to obtain information on type, quantity and quality of medical and radiation oncology referrals received by Christchurch Hospital Dietitians over a three month period.

MethodAll referrals received from September to November 2016 were collected and entered into audit spreadsheet.

A quality referral is classified as one which includes all of the following criteria: • Name of referrer and designation• Type/location of cancer• Treatment modality (medical or radiation treatment)• Correct Malnutrition Screening Tool Score (MST) or recent weight history

specified• Current weight• NHI number• Reason for referral

Results• 111 referrals were received• 95 via email, 14 via fax, 2 via dietitian handovers• 15 were from medical oncology and 96 were from radiation oncology• 78 were for curative intent and 33 were for palliative intent

Referrer Designation:• 77 from CT planning• 10 from Radiation Therapists (on treatment machines)• 7 from Dosim• 2 from Dietitians• 6 from Oncology Outreach Nurses• 2 from Cancer Nurse Coordinators• 3 from Consultants• 2 from Registrar• 2 no referrer details

This graph shows the types of cancers the referrals were received for. Some types of cancers were grouped for easier analysis. The most common cancers were head and neck (28), lung (25) and oesophagus (13).

Figure two and three show that even though there was an MST score on 78% of referrals it was only correctly calculated on 28% of referrals. Therefore there were potentially a lot of referrals sent that did not meet referral criteria.

Figure four shows the comparison of MST score on referral with correctly calculated MST score. The current Radiation Oncology referral criteria advises to refer to dietitian if an MST score is greater than or equal to three. This figure shows that when the MST score is calculated accurately there is an increase in referrals with a score below three that did not meet criteria. There are only 19 referrals with an MST greater than or equal to three when accurately calculated compared to 56 when calculated incorrectly. This large decrease in numbers will lead to less dietitian referrals and allow the dietitian to see those most in need of review and to triage the referral more accurately.

Quality Referral Criteria 76% of all referrals met the requirements of the quality referral criteria 60% of medical oncology referrals met checklist criteria 78% of radiation oncology referrals met checklist criteria

ConclusionOnly 28% of referrals had an accurate MST score which is a validated tool to screen for malnutrition. Radiation referrals were more likely to meet the quality checklist compared to medical oncology referrals. Quality information and accurate malnutrition screening scores allow the dietitian to triage referrals more accurately. A review of referral forms and training for referrers is recommended to improve quality and accuracy of referrals received.

Figure 2. MST completed on referral form

Figure 3. Accuracy of MST on referral form

No MST 22%

Completed MST 78%

No MST 21%

Correct MST 28%

Incorrect MST 51%

0

30

13

27 28

4 4 4 42

5

14

5

colorecta

l / anus

lung / chest

head and neck

brain / GBM

breast

gynaecologica

l

melanoma

prostate

lymphoma

oesophagus

other

25

20

15

10

5

Figure 1. Dietitian referrals by cancer type

num

ber

cancer type

0

30

MST 0 MST 1 MST 2 MST 3 MST 4 MST 5 MST 6 MST 7 no score not able to calculate

MST

25

20

15

10

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Figure 4. Comparison of MST on referral with correctly calculated MST score

num

ber

MST score

MST on referral

correct MST

Dietitians New Zealand News

YoumayhavenoticedthatthenewandimprovedwebsiteforDietitiansNewZealandwaslaunchedlastweek.Theyhaveputalotofhardworkintoitovertime,andarenowwelcomingthoughtsandfeedback.IfyouhaveanythoughtsorfeedbackonthewebsitepleaseeithergetintouchwithDietitansNewZealanddirectly,orsendyourfeedbackthroughtothebranchandwewillforwarditon.TheDietitansCouncilwillsooncallfortwonewcouncillors,andthisisthechanceforDietitianstolearnnewskills,influencehealthpolicy,contributetoyourprofession,andhavefun.Keepthisinmind,andkeepaneyeoutforthenextcallforvolunteers!

News and Views

ThefollowingreviewwaspublishedontheMOHsitejustrecently:HowWeEat–Reviewsoftheevidenceonfoodandeatingbehavioursrelatedtodietandbodysize

Recently,theHealthyFoodGuidehascreatedaTVshow!Itaimstogiveviewers‘toolstomakeyourlifebetternomatterwhatyourhealthorfamilysituation’.Itwillrunfor10weeksanddiscussmythsandnutritionjargon,providetipsandtricksandoverall‘howto’forhealthyeating,aswellasplentyofrecipesalso.TheshowscreensonChoiceTVat8.30pmThursdays,anditrepeatsonFridayat9.30amand2pm.Itisgreattoseesomethinglikethishittingthescreenstomakeadifferencetothepopulationandtospreadhealthyeatingmessages!MoreinformationcanbefoundonlineattheHealthyFoodGuidewebsite,andmakesureyoutuneintoseefellowcolleaguesmakeadifference.

ObservationattheRoyalPrinceAlfredHospital,FoodAllergyUnit,Sydney,AustraliaOnthe9thSeptemberIspentthedayattheRoyalPrinceAlfredHospital(RPAH),AllergyUnitobservingtheiradultsclinic.ThankyoutotheCanterburyBranchofDietitiansNewZealandforfinancialsupporttoattendthisday.TheAllergyUnitisattachedtotheDepartmentofClinicalImmunology,RPAHandisaffiliatedwiththedisciplineofmedicineattheUniversityofSydney.RPAHisthepremierteachinghospitalwithintheSydneyLocalhealthDistract.It’slocatedinCamperdown,abouta10minutebusridefromCentraltrainstation.Theunitrunamultidisciplinaryclinicalservicefortheassessmentandmanagementofawidevarietyofallergicandrelateddisordersincludingfoodintolerance.Theunithaseightdoctors,fournursesand13dietitians.DrRobertLoblayisDirectorandClinicalImmunologistandDrAnneSwainistheHeadDietitian.InmyprivatepracticeIspecialiseinthedietarymanagementofgastrointestinaldisordersinadults.SeveralyearsagoIwasregularlyusingtheRPAHEliminationDietinmypractice.However,IstoppedusingitoncethelowFODMAPdietbecameavailable.OverthelastsevenyearsIhaveusedthelowFODMAPdietwithgreatsuccessformanypatientswithfunctionalgutsymptoms.ButnoteveryoneimprovesonalowFODMAPdiet.Also,itisnotindicatedforupperGIsymptomsorsymptomsoutsidetheGItract.LatelastyearIdecidedtoupskillintheareaoffoodchemicalintolerance.IpurchasedtheRPAHresourcesandalsocontactedAnneSwainforadvice.ShewasextremelyhelpfulandalsoinvitedmetospendadayattheRPAHunit.OnthedayIattendedIsatinonsevendietitianconsultations.Theseincludedinitialconsultationsandfollow-ups.Thefinalpatient(femaleinhermid30’s)ofthedayhadrecentlybeenrushedtoEmergencywithananaphylactoidreaction.Thispresentsthesamewayasanaphylaxisbutisnon-IgEmediated.DrRobertLoblayhadaskedthepatienttoseeAnnetoidentifytriggers.Shewasonastricteliminationdietandusinguncolouredandunscentedpersonalcareproductsandcleaningproducts.Unfortunatelyaverythoroughhistorywasunabletoidentifythetrigger(s)forthisepisode.DrLoblayexplainedthiscanoccasionallyhappen.Veryscaryforthepatient.Anotherpatient(femaleinherlate20’s)hadsuspectedEosinophilicoesophagitis.DrLoblaysawherforathreehourconsultationandshewastohaveagastroscopytoconfirmthediagnosisthefollowingweek.ShealsosawAnneforeducationtofollowthesixfoodeliminationdiet(excludingwheat,milk,eggs,soy,nuts,fish/seafood)andtoexcludenaturalandaddedfoodschemicals.Anneexplainedthatoneormoreofthesixmainallergenscancauseinflammationoftheoesophagusbutthatfoodchemicalscancauseirritation.

Conference Report from Sally Watson

TheRPAHdietitiansareveryskilledateducatingpatientstofollowtheeliminationdiet(alsoknownasalowchemicaldietorFailsafediet).TheyuseaflipcharttoeducatebutareintheprocessofchangingtoPowerPointslidesdevelopedbyAnne.EachpatientreceivesacopyoftheRPAHEliminationDietHandbook.OverviewofDietaryInvestigationusedatRPAHAllergyUnitStep1:DiagnosticEliminationDietPatientfollowsamoderateorstricteliminationdietforthreetosixweeks.Thedietexcludesnaturalfoodchemicals(salicylates,aminesandglutamates)andcertainfoodadditives.Ifthepatienthasgutsymptomswheat,milkand/orsoymayalsobeexcluded.Step2:FoodChallengesOncesymptomshavesettled(andthenhadatleastfivedaysinarowwithoutsymptoms)thepatientdoesaseriesofchallengesusingspecificfoods/foodchemicalstodeterminewhichtheyaresensitiveto.ForparticularlysensitivepeopleRPAHusescapsulechallenges–double-blindwithplacebos.Thecapsulescontainahighdoseofasinglesubstancedesignedtoexceedsymptomsthresholdrapidly.Step3:PersonalisedDietOncethepatienthasidentifiedwhichfoods/foodchemicalsare“safe”thedietitianhelpsthemtopersonalisetheirdiet.Theystayonthisforatleastfourweeks.Step4:LiberalisingtheDietLiberalisingthedietisdonebypatientsexploringtheirdosethresholdforeachofthefoods/foodchemicalsthattriggeredchallengereactions.Thisisatrialanderrorprocessanddonegraduallyinasystematicwaywithdietitiansupervision.RPAHhaverecentlyreleasedtheRPAHFoodIntoleranceHandbookVolume2:Challengesliberalisingandmanagement.ThisisdesignedtobeusedinconjunctionwithVolume1:RPAHEliminationDietHandbook.RPAHresourcesincludingthetwohandbooksandtheFriendlyFoodRecipeBookcanbeorderedviathefollowinglink:http://www.slhd.nsw.gov.au/rpa/allergy/resources/ordering.htmlTheAllergyUnithavealsodevelopedawebsitetosupporthealthprofessionalswithaninterestinfoodallergy,foodintoleranceandcoeliacdisease.ThesiteiscalledAllergyDownUnder.Tovisitgoto:http://allergy.net.au/AsaresultofmyvisittoRPAHIhaveupdatedtheresourcesIusewithmypatients.Ihavealsodevelopedawalletsizedcardwhichliststhefoodadditivestoavoidonalowchemicaldiet.Ifyouregularlyseepatientswithfoodallergyorfoodintolerance,IencourageyoutofindoutmoreabouttheRPAHEliminationDiet.AnneSwainandherteamofdietitiansareextremelyhelpfulandverywillingtosharetheirknowledgeandexpertise.SallyWatsonConsultantDietitian

What’s new on HealthInfo AmobileversionofHealthInfoiscurrentlybeingdevelopedandshouldbelivebyAugust2017.Updatednutritioninformationo EatingandlifestyleguidelinesforIBS

http://www.healthinfo.org.nz/Eating-guidelines-for-irritable-bowel-syndrome-IBS.htm

o FoodintoleranceandlowFODMAPeatinghttp://www.healthinfo.org.nz/Food-intolerance-low-FODMAP-eating.htm

NutritioninformationindraftThefollowingarecurrentlyindraftandshouldbeavailableonHealthInfointhenextfewmonthso Stepstoreduceyourcancerrisko Howtoloseweight–thisnewsectionwillreplacethecurrentinformation.Itincludesthefollowingnew

pages:o FindingoutifIamahealthyweighto Howtoloseweighto Healthyeatingtoloseweighto Beingactivetoloseweighto Weight-lossprogrammesandresourceso Weight-lossmedicationsorweight-losssurgery

FordetailsaboutothernewandupdatedtopicsonHealthInfogoto:http://www.healthinfo.org.nz/Whats-new-on-HealthInfo.htmDietandlifestyleeducationforadultsinCanterburywithirritablebowelsyndromeInanewsletter,latelastyearIoutlinedaproposalsubmittedtoPlanningandFundingforatwo-tieredprogrammeformanagingadultswithIBS.Thisinvolvespracticenursesdeliveringfirst-linehealthyeatingandlifestyleadvice.Followedbydietitan-ledgroupeducationonthelowFODMAPdietforthosewhodon’timproveandmeetspecificcriteria.Atrainingpackageforpracticenurseshasbeendeveloped.ThetrainingwillbedeliveredataCanterburyInitiativeeducationsessionforpracticenursesonthe12thJune.FundingforthedieteticandadministrationresourceforthegroupFODMAPeducationisstillbeingdiscussedwithPlanningandFundingandPegasusHealth.Thegroupsareunlikelytostartthisyear.WehavebeenindiscussionwithOtagoUniversityandwearehopefulthataMastersofDieteticsstudentwillevaluatetheprogramme.

AlliedHealthwaysTheCanterburyInitiativehasdevelopedanewwebsitecalledAlliedHealthways.ThePathwaysfamilynowincludesfourwebsites,eachwithadifferenttargetaudience:

- CommunityHealthPathwaysforprimarycareteams- HospitalHealthPathwaysforresidentmedicalofficers- AlliedHealthwaysforalliedhealthprofessionals- HealthInfoforpatients

AlliedHealthwaysiscurrentlyinadesignphase.IthasasimilarlookandfeeltotheexistingthePathwayswebsitesbutmultiplecoloursarebeingusedtorepresentthedifferentalliedhealthdisciplinesworkingtogethertoimprovepatientcare.TherewillbelinkagestotheexistingPathwayssites.Thereareseveralpathwaysindraftform,reflectingmusculoskeletalworkdoneoverthepast18months.NewpathwayswillbedevelopedaccordingtotheCanterburyInitiativemodel.Thisinvolvesaprocessofgettingkeypeopletogetherinaworkshoptoidentifyissues,problemsolveandultimatelygainagreementonthecontentofapathway.Somepathwayswillbedisciplinespecific,whileothers,suchasweightmanagement,fallspreventionandphysicalactivitywillbemulti-disciplinary.OnceliveAlliedHealthwayswillprovideaplatformtoincreasevisibilityandconsistentcommunicationofalliedhealthprotocolsandpackagesofcare.AlliedHealthwaysisnewandevolving.ThereisarealopportunitytobuildlinkagesandcommunicationbetweenalliedhealthprofessionalsandacrosstheCanterburyhealthsystem.Thiswillhelptoraisetheprofileandunderstandingofwhatalliedhealthprofessionalsdo.SallyWatsonDietitianLiaisonCanterburyInitiative0276872302

CANTERBURY INITIATIVE ALLIED HEALTH EDUCATION EVENING

Child healthy weight - tools for discussing the issue with your patient and their family Allied Health services for children—what services are provided by my Allied Health colleagues

Details

• Monday 19 June 2017 6:30 pm—8 pm

• The Atrium Hagley Netball Courts Hagley Ave

• To Book Go to HealthPath-ways, Education Services, Calendar of events and select Allied Health educa-tion 19 June.

Contact us: education@healthpathways.org.nz

Child Healthy Weight With child obesity an increasingly challenging issue, the goal of this session is to update Allied Health practitioners on the interventions and resources available to support children and their families. The session will also cover the size of the problem, what is being done and where Allied Health practitioners fit in this pic-ture.

Topics & presenters include: • How big is the child obesity problem and what is being done about it?

Sally Watson, Dietitian Liaison, Canterbury Initiative

• Interventions and resources available—Lucy Carey, Dietitian, Pegasus Health

• Physical Activity– Nadine Milmine, Active Canterbury Network Co-ordinator, Pegasus Health

Allied Health services for children A series of short presentations to raise awareness of the range and breath of ser-vices offered by Allied Health practitioners to children. This will be followed by a panel question and answer session.

Presentations by: • Child Health Support Service Pegasus

• Dietitian

• Occupational Therapist

• Optometrist

• Physiotherapist

• Podiatrist

• Speech Language Therapist

Supporting children and their families